Healthcare Provider Details

I. General information

NPI: 1992834436
Provider Name (Legal Business Name): LENORE ANNETTE IVERSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S GLENOAKS BLVD STE 200
BURBANK CA
91502-1423
US

IV. Provider business mailing address

1240 MEADOWBROOK AVE
LOS ANGELES CA
90019-2869
US

V. Phone/Fax

Practice location:
  • Phone: 818-441-7800
  • Fax: 818-441-0014
Mailing address:
  • Phone: 323-938-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA43593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: